The Police State of Medicine (July/August 1998)

As the only physician giving a presentation for today's program --- perhaps I should have worn a bull's eye. I hope you will lend me your attention. I assure you that I did not come here to praise my profession --- I simply do not wish to see it buried. I came to speak about honor and the Law. I will proceed from the assumption that in this audience are men and women who do not simply wear the title "honorable," but who uphold justice and the honor of their profession.
I wish to speak to those whose goal is not simply to collect a piece of a $3 billion pie, or to "minimize the risk of fines and penalties" for whatever they are doing, but to end the scandalous outrage of fraud in American medicine. Our goal should not be to work at the problem, or to spend money on the problem, but to...

Introduction
First, I would like to thank the Drug Policy Foundation for the opportunity to speak to you today. I understand that the rights of patients to effective treatment and the impact of current drug policy on the patient-doctor relationship are very much on your minds, as they are on mine. I offer my story as a case study of regulatory abuse, as we try to fashion an adequate political and legal response to what I think of as "The Police State of Medicine."
I will begin with a review of the legal events in my case. I will then tell you about my patients and the impact the legal action against me had on them. Finally, I would like to address two related questions: How does the police state of medicine affect medical care? And what can we do about it?
What Happened to Me?...

For many Americans, their fight against cancer is nothing compared to their battles with the Food and Drug Administration (FDA). Just ask the many patients of Dr. Stanislaw Burzynski. They'll tell you about their 14-year war with the FDA and that they won!
Yet, They Still Implore Congress to Reign in the FDA
Here's how their long battle evolved. Since 1977, more than 2,500 cancer patients have sought out an experimental drug named Antineoplaston (meaning anti-cancer) developed by Dr. Burzynski, a polish-born physician and biochemist. Many of the patients had been diagnosed with terminal cancer after chemotherapy and radiation failed to reduce their tumors. Others opted for Antineoplaston treatment as their first choice. Either way, patients (including patients who received...

I am the first doctor in the history of the United States legal system criminally convicted for using medical judgment. My conviction in 1993 was for reckless endangerment and willful neglect (both misdemeanors and Health Code Violations) for ordering the transfer of a completely stable nursing home patient [to a hospital across the street] in the afternoon instead of the morning --- "a 10 hour delay" --- on Sunday, May 20, 1990. I was deemed negligent even though I examined the patient three times on that Sunday (7 a.m., 2:30 p.m. and 5:30 p.m.). One Federal District Judge is on record saying that my case should be reversed and if he had the power, he would have overturned it. Another Federal District Judge wrote a dissenting opinion stating that I was innocent (but he was overruled 2 to...

Orange County Jail, Santa Ana, California Brad Gates, Sheriff Bookkeeping Number 91-347438
The cold concrete benches were hard, very hard, and because of the noise and the cursing of other prisoners, sleep was impossible. The "booking" consumed more than 24 hours; afterward, the newcomer was marched along the side of the hall, silently, according to the barking orders of the jail deputy. He was then shown a second-tier steel bunk on which to roll the smelly and pillowless one-inch foam rubber pad. Scattered around the "tank" were 64 other prisoners and a couple of stoolies, who tried to figure out what this gray-haired, overweight, inmate might have done. Was he a drug dealer? A child molester? Or merely some poor fellow behind on his child support payments?
The new stranger was a 1959...

Advances in the conquest of pain are underway, we are told, in Europe, England and the U.S. Pain clinics and pain specialists are increasing, as are hospices and pain-management courses in medical schools. This sounds wonderful, but the reality does not seem as wonderful as the labels. Our check into these facilities and their methods indicate that they seem dedicated more to teaching people to endure pain than to efforts to alleviate it. Europe, an older and more sophisticated culture, may take a less rigid position than is adopted here --- for we are a nation of extremists --- but that's only an assumption. The fact is that medicine has never really regarded pain as important, although pain is what sends people to doctors in the first place.
When Jeffrey Bernard, the famous columnist in...

Shortly after retiring, I was invited to become the third associate of two "retired" physicians conducting a walk-in practice dealing to a great extent with the medically indigent. Shortly thereafter, medical problems claimed my two associates and they quit: I continued solo five mornings a week.
Although I rarely, if ever, prescribed "pain killers" or anything more than non-steroidal anti-inflammatory drugs (NSAIDs) for the bulk of my mainly itinerant patients, I inherited about 10-15 Chronic Pain patients for whom I prescribed methadone. Chronic Pain patients treated with narcotics will become narcotic dependent, a simple fact that causes turbulence in the posse mentality of authorities and galvanizes them to action.
Within a brief period, I became the target of a major investigation by...

They're federal agents...they're coming through the front door of YOUR office to conduct a Medicare investigation...their guns are drawn and they're pointed in YOUR direction. Tiny little beads of sweat start to form on your forehead as you peer down the barrel of the agent's gun, anxiously waiting for what comes next. Make my day? Nope. A riddle: What's vague, undefined and can hurt you...a lot? Answer: "Medical Necessity."(1)
This seemingly innocuous term poses a significant threat to physicians under both the Medicare program and the Health Insurance Portability and Accountability Act (HIPAA). Medicare officials or overzealous prosecutors clearly can use the term medical necessity to mean whatever they say it means. And, who might be making these determinations? Well, a General...

On April 27th, the AMA hosted a self-described "Flyin" for physicians to express their comments and outrage about the new E&M Documentation Guidelines (the "Guidelines") due to go into effect on July 1st. As Dr. Nino Camardese discovered when he flew to this event, however, the AMA denied entrance even to its own longstanding members, unless handpicked beforehand. In fact, the AMA limited attendance and discussion to a predetermined set of physicians and administrators.
By coincidence, Dr. Jane Orient, Executive Director of AAPS, qualified for admission by virtue of her leadership position in her county medical society. After an initial delay in conceding that Dr. Orient may attend, the AMA ultimately allowed her to participate.
At the meeting, numerous physicians expressed their...

Dear Editors,
Thank you indeed for the copies of the Medical Sentinel. I am reading them slowly, with great interest and delight in the depth of your Editor-in-Chief's classical education and scholarship.
I find your choice of articles to be an outstanding selection, a gathering of minds occupied as the mind should be with attention to historical foundations while examining the follies that choke our mental productiveness today.
One member of your editorial board intrigues me ---- Russell Blaylock, M.D. Some 26 years ago, I knew a fine surgeon at Ochsner Foundation Hospital with the same name...
I have enclosed a check for two subscriptions. Please enter a subscription for me, and a second one for a dear physician friend...
Barbara C. Anderson Port St. Joe, FL
Correspondence originally...

Thank God for the Association of American Physicians and Surgeons (AAPS). While the AMA has been busy selling its name to the Sunbeam Corporation and giving its seal of approval to HCFA in return for profits from the sale of coding books, the AAPS has shown yet again it's unwavering commitment to the patient-doctor relationship and professional ethics. While the AMA is busy collaborating with the enemy (HCFA) to bring us increased government bureaucracy, the AAPS is fighting back by filing a lawsuit against HCFA.
For those who say that you have to "go along to get along," and you "can't fight city hall," we note it was the AAPS that successfully sued the Clintons over the illegal secrecy of the Health Care Task Force (AAPS v. Clinton --- judgment in favor of AAPS $285,000 against the...

"Life, liberty and the pursuit of happiness" is a myth for some in this world. Consider a country that would limit the amount of money that certain highly trained workers could earn for doing their work no matter what their skill level. Consider a country that encouraged a non-competitive environment for only this type of worker. Consider a country that would make it a crime for these workers to privately negotiate compensation outside of a government-imposed fee structure. Consider a country that would selectively drive the incomes of these workers' down at a time when other workers in other industries enjoyed increasing prosperity. Consider a country that would allow monopolistic companies to also lower their payments to these workers, just like the government. Consider a country that...

Dear Editor,
I heartily appreciated the editorial by Dr. James Weaver entitled, "Physicians Hear This: Say Goodbye to Third-Party Payment or Die" [Medical Sentinel 1998;3(1):26-28].
To address one point in this article, i.e., that fee-for-service engenders a conflict to overtreat patients, I think that this conflict will be removed if the third-party payer is in fact removed from the patient examination room. That is, if the relationship between the payer and the third-party payer does not include the physician, or if in fact there is no third-party payer, the patient himself will understand the cost of medical care and begin to make informed decisions. This, in fact, will lead to patients seeking physicians, who are known to practice quality care and not overutilize unnecessary medical...

Dear Dr. Orient,
I have so many articles piled up on my desk that I want to share with you and other AAPS members, it's becoming more and more difficult to get to them all.
In the event that I end up in jail, however, for participating in the non-violent march to the local IRS office with other members of the Independent Citizens Committee for the Fair Treatment of the Lapp Family, I just had to get this one last piece off. It's a real gem!
Last month, I wrote to the Gerry Town Court to find out what happened to the Medicare investigator who was arrested and jailed on April 8, 1997 for making sexually harassing phone calls from his hotel room while he was in Jamestown, New York to conduct a "Medicare investigation" at the hospital. Here is the reply that I got. I think it's from the Gerry...